Provider Demographics
NPI:1427343839
Name:BEATY, VIRGINIA L
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:L
Last Name:BEATY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 W 117TH ST
Mailing Address - Street 2:T-2226
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-1747
Mailing Address - Country:US
Mailing Address - Phone:216-325-0773
Mailing Address - Fax:216-325-0783
Practice Address - Street 1:3100 W 117TH ST
Practice Address - Street 2:T-2226
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-1747
Practice Address - Country:US
Practice Address - Phone:216-325-0773
Practice Address - Fax:216-325-0783
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03322044-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist